If there is suspicion for surgical abdomen (e.g. appendicitis, cholecystitis) consultation with general surgery may be appropriate.

Discussion with radiologist regarding optimal imaging techniques during pregnancy may be useful (diagnostic performance of some studies, e.g. ultrasound, may be affected by operator experience).

If ureteral obstruction persists, then consultation with urology for possible ureteral stents or percutaneous nephrostomy.

3. Management

Antepartum/Intrapartum/Postpartum

Obtain IV access and aggressive hydration (patients often have dehydration due to vomiting and decrease po intake).

IV narcotics (Morphine, meperidine, or butorphanol are most common) for pain control.

IV antiemetics.

Assessment for the presence of obstruction and/or infection.

Continue aggressive IV hydration to facilitate passage of stone.

If evidence of infection, then IV antibiotic therapy.

Continuous epidural anesthesia has been used for pain control in some cases.

Surgical therapy: if obstruction continues or recurrent obstruction develops, placement of ureteral stents or even percutaneous nephrostomy may be required if medical therapy fails (most stones less than 4 mm will pass spontaneously).

Lithotripsy contraindicated during pregnancy.

4. Complications

UTIs and progression to pyelonephritis can occur with obstructing calculi.

Chronic renal insufficiency can develop due to recurrent/repetitive pyelonephritis associated with calculi.

Acute renal failure extremely uncommon.

If ureteral stents required, require replacement 4-6 week intervals.

If percutaneous nephrostomy placed, can develop migration of catheter and need for replacement; also risk of cellulitis.

More in Obstetrics and Gynecology

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